Germ Warfare – Ghana

In Ghana, 84,000 people die of diarrhoea-related causes each year, with 25 per cent being children under five years old. Although water and sanitation conditions are improving, a change in attitude is needed if people are to benefit fully from the opportunities for improved health. In Ghana, people wash their hands in water before they eat. However, it is important that this water is not contaminated, particularly as people usually eat with their hands. Unable to guarantee that the water is not contaminated, the government has launched a campaign to wash with soap before eating. This campaign involves televised ‘infomercials’ and the sale of soaps made from local products.

Water and Sanitation

© Liz Fredericks / ITDG

In 2002, 83 per cent of the world’s population – around 5.2 billion people – used improved drinking water sources. These include piped water connections and standpipes. The good news – gains in all regions since 1990 – is counterbalanced by the fact that 1.1 billion people were still using water from unimproved sources in 2002. In sub-Saharan Africa, 42 per cent of the population still have no access to safe water. The lowest levels of access to drinking water are found in sub-Saharan Africa and in Oceania. Global sanitation coverage rose from 49 per cent in 1990 to 58 per cent in 2002. Still, some 2.6 billion people – half of the developing world – live without improved sanitation. Sanitation coverage in developing countries (49 per cent) is only half that of the developed world (98 per cent). Global sanitation coverage figures from 2002 indicate that, of every 10 people, roughly five have a connection to a piped water supply at home (in their dwelling, plot or yard); three make use of some other sort of improved water supply, such as a protected well or public standpipe; and two are un-served, with no choice but to rely on potentially unsafe water from rivers, ponds, unprotected wells or water vendors.

The way that people secure their drinking water has a direct impact on their health and on the economic status of households. In households using only a remote and unprotected source, health can be jeopardised by water contamination. The quantity of water collected is likely to be too small for effective hygiene, even if bathing and laundry are carried out at the source. Using an improved water source, such as a protected spring or well within a reasonable walking distance, provides substantial health benefits. But hygiene may still be compromised and water may be contaminated during transport and storage.

© Annie Bongeroth / ITDG

Once water is available at home – through a yard or house tap, for example –hygienic behaviour and the maintenance of water quality becomes easier. Major improvements in household health usually accompany the use of piped water at home. Similarly, the time saved in not having to collect water may also contribute significantly to improvements in the household economy. However, Ghana does not have a high proportion of its consumed water piped into homes, as shown in Table 1. What these figures do not show is that some areas are vastly below the average (such as Volta and Eastern regions), while others are higher (such as the Central region). The figures also conceal the fact that most of the piped water systems along the coast are severely affected by salinity and are dysfunctional.

Table 1 Sources of Drinking Water in Ghana

Source: WSSPSII, 2003

Health in Ghana

According to UNICEF, Ghana has amongst the lowest coverage (11 per cent) of adequate sanitation in the world. Three areas for concern have been placed at the heart of Ghana’s problems of health and sanitation:

1. Household latrines
The coverage for sanitation in many small towns is inadequate at less than 30 per cent.
2. Refuse collection
Improvement in refuse collection and/or disposal is a major concern to most small towns. Open landfills cause damage to the water resources in the vicinity besides posing a direct health risk.
3. Storm water
Many small towns in Ghana lack storm drainage systems, which contributes to the accumulation of pools of stagnant water.

The Ghanaian national incidence of diarrhoea is 18 per cent. Some parts of the country have higher levels, such as Northern Ghana with 31 per cent. The immediate factors that contribute to the problem of diarrhoea are the lack of access to health-determining facilities, specifically water and sanitation, as well as a lack of health education. The high incidence of diarrhoea in the northern parts of the country was attributed partly to the lack of access to clean drinking water and proper sanitation. Water-borne diseases are a huge problem in Ghana, and a high proportion (81 per cent) of the rural population relies on untreated water. Households without access to piped water in urban areas also rely on a variety of less reliable and unhygienic sources, including mobile water tankers, fixed water vendors, shallow wells, boreholes, and unprotected springs.

Increasing access to adequate water and sanitation facilities is a key to achieving sustained poverty reduction through improved health. However, in Ghana, the problem of water-borne diseases does not stop once water is piped to the home or community. Traditional Ghanaian foods, such as fu fu and banku, are eaten with the hands. People in Ghana wash their hands before eating, but only rinse them in water without soap or any other cleaning agent. The water that is used is often contaminated. Most of the causes of diarrhoea could be prevented by proper sanitation and hand washing with soap. These factors are often ignored or taken for granted by the public. To improve hygiene before eating, the Community Water and Sanitation Authority (CWSA), based in Accra, has launched a campaign to encourage the use of soap before meals. The campaign includes television ‘infomercials’ about the risks of eating with hands that are washed only in water, especially water that has been left standing. To help the campaign, CWSA has entered a partnership with Getrade, which sells soap made from local Ghanaian ingredients. Other organisations involved include Unilever Ghana Limited, PZ-Cussons Industries Limited, the World Bank, UNICEF, London School of Hygiene and Tropical Medicine, and the World Health Organisation. The campaign particularly targets mothers and children in basic schools, as they are the most vulnerable to diseases such as diarrhoea.

Getrade

© Annie Bungeroth / ITDG

Getrade is an export house within Ghana's 'non-traditional' export industry. Set up in 1990, it now works with over 400 artisans and farmers. Getrade believes in developing the artisan sector as a means of achieving economic growth and promoting social progress. Getrade strives for fairness in its dealings with all producers, equality in the provision of available opportunities, and transparency. It aims to establish a network that extends beyond trade, providing support to producers in the form of finances and organisation, product development, export handling, marketing assistance and social funding.

In 1995 the UNISPAR-Africa (University﷓Industry Science Partnership in Africa) programme provided a grant for technology development relating to the preservation of different locally available plants that may be exported. This included hibiscus leaves and flowers, lemongrass and cinnamon, all of which were intended to be used as beverages. Although the process of preservation of these plants already existed, the challenge was to develop a low-cost process and packaging technique that will deliver the product in a form preferred by consumers. As a result of this work, Getrade and the Department of Biochemistry at the University of Science and Technology, Kumasi, were able to develop low-cost products that could satisfy the Food and Drug Laws of European countries. In 1996 Getrade exported herbal teas or tisanes made from lemongrass, cinnamon and hibiscus. To support the programme of health education in Ghana, Getrade is now selling soaps that are made in small towns by small producers from natural, locally grown materials.

Cleaning Habits

The campaign initiated by CWSA has brought a new dimension to health education in Ghana. With improvements being made in the provision of water and sanitation (although there is still a long way to go), the government and supporting organisations are turning to the hygiene habits of the general population. By using soap before meals, both adults and children are more likely to avoid water-borne diseases such as diarrhoea. These initiatives are essential to support infrastructural improvements to water supply if the people of Ghana are to keep disease at bay on the long run.

Acknowledgements

Practical Action would like to thank the Community Water and Sanitation Authority and the Vodafone Group for providing information and helping in this case study.

Further Information

Reference Material

Government of Ghana (2003). Water and Sanitation Sector Programme Support Phase II (WSSPSII).

UN Children’s Fund (2004). Meeting the MDG Drinking Water and Sanitation Target: A Mid-term Assessment of Progress. UNICEF and WHO.

Participating Organisations

Building Partnerships for Development in Water and Sanitation
Prince Consort House
27-29 Albert Embankment
London SE1 7UB
United Kingdom
Tel: +44 (0)20 7793 4557
Fax: +44 (0)20 7582 0962
Email: info@bpd-waterandsanitation.org
Website: http://www.bpd-waterandsanitation.org/

GETRADE
Website: http://www.ghanacityguide.com/vfresh.htm
Outlets in Ghana:
Kumasi – Hygenus Marketing – Tel: 051-23908
Ho – Biss Integrated – Tel: 091-27961
Sunyani – Asante & Asante – Tel: 061-27000
Eastern Region – Virtue – 0832-22084
Takoradi – Nnoma – 031-26989
Takoradi – Sabmenas – 031-21623
Cape Coast – Rock Saforo – 027-581190
Tema – Olive Hair Centre – 022-201371

London School of Tropical Medicine and Hygiene
Keppel Street
London
WC1E 7HT
UK
Tel: +44 (0) 20 7636 8636
Fax: +44 (0)20 7436 5389
Website: http://www.lshtm.ac.uk/

UNICEF
P.O. Box 5051
Accra-North
Ghana, West Africa
Tel: + 233-21-773853
Fax: + 233-21-773-147
E-mail: accra@unicef.org
Website: http://www.unicef.org/

UNISPAR-Africa
Engineering and Technology Division
UNESCO Headquarters
Dr. T. Marjoram
1 Rue Miollis
75732 Paris Cedex 15
Tel: + 33 1 45 68 41 78
Fax + 33 1 45 68 58 20
E-mail: unispar@unesco.org
Website: http://www.unesco.org/unispar/

Supporting Organisations

Department for International Development (DFID)
1 Palace Street,
London SW1E 5HE
UK
Tel: +44 (0)20 7023 0000
Fax: +44 (0)20 7023 0019
E-mail: enquiry@dfid.gov.uk
Website: http://www.dfid.gov.uk/

Vodafone Group Foundation
Vodafone House
The Connection
Newbury
Berkshire RG14 2FN
UK
E-mail: groupfoundation@vodafone.com
Website: http://www.vodafonefoundation.org/

USAID
Information Centre
Ronald Reagan Building
Washington, D.C. 20523-1000
USA
Tel: +1 202-712-4320
Fax: +1 202-216-3524
Website: http://www.usaid.gov/

Resources

Practical Action Technical Information Service
Schumacher Centre for Technology Development
Bourton Hall
Bourton On Dunsmore
Warwickshire
CV23 9QZ
UK
Tel: +44 - 01926 634462
Fax: +44 - 01926 634401
Website: www.practicalaction.org/
technicalinformationservice

ITDG Publishing
Schumacher Centre for Technology Development
Bourton Hall
Bourton On Dunsmore
Warwickshire
CV23 9QZ
Tel: +44 (0)1926 634501
Fax: +44 (0)1926 634502
E-mail: marketing@itpubs.org.uk
Website: www.itdgpublishing.org

TVE/ Practical Action gratefully acknowledge support for the HANDS ON programmes from the UK's Department for International Development (DFID), the European Commission (EC), the UN Foundation and UNDP/The Equator Initiative in collaboration with the Government of Canada, IDRC, IUCN, BrasilConnects and the Nature Conservancy.